Excited Delirium: An Introduction

Over the past decade, increased attention has been paid to the sudden and seemingly inexplicable deaths of some highly agitated subjects being held in police custody. In most of these cases, the force required to restrain or incapacitate the suspect was not sufficient to cause death.

Our colleagues in Miami-Dade County, Florida, first described the syndrome of excited delirium associated with cocaine abuse. The symptoms of excited delirium include bizarre and/or aggressive behavior, shouting, paranoia, panic, violence towards other people, unexpected physical strength, and hyperthermia. Throughout the United States and Canada, these cases are frequently associated with psychostimulant abuse, representing the extreme end of a psychiatric continuum of drug abuse effects. However, reports of acute exhaustive mania, physical restraint, Pepper Spray or TASER and sudden death also have been reported that are not related to abused drugs, suggesting further that an underlying central nervous system disorder was the precipitating cause of lethality. Such victims of excited delirium have provoked allegations of police misconduct, unnecessary force and improper TASER deployment.

Medical examiners often have extreme difficulty in identifying the cause of death, but frequently drug intoxication is considered as a contributing factor or cause of death. While the precise cause and mechanism of these deaths remain controversial, we have demonstrated abnormalities in brain that define and confirm the occurrence of the excited delirium syndrome.

What to know:

Fact: ExDS is a medical emergency that presents itself as a law enforcement problem.

– Early and advanced coordination with EMS is key.

Fact: ExDS is not easy to recognize.

– Training is important so that dispatch or other personnel recognize behavioral signs.

Fact: ExDS containment requires backup personnel.

– Do not approach until it is safe to do so and always ensure several officers are present.